by Marissa Lorenz
Representatives of the Engaged Citizens for a Healthier Grand County appeared before the Board of County Commissioners (BOCC) on Tuesday to propose a new Grand County Board of Health (BOH), independent from the concurrently-serving BOCC board. Under Colorado law, counties with populations over 100,000 must have an independent board of health. However, in smaller, mostly rural counties, the law permits county commissioners to double as a board of health.
That structure was challenged this past year when a group of Colorado legislators introduced House Bill 21-1115, which would have prohibited county commissioners from serving on a county health board, even in cases of a home-rule charter. It was proposed, in many ways, in response to the COVID-19 pandemic and citizen concerns that public health decisions had been politicized during the crisis.
At the time, many county commissioners strongly opposed the bill. At a January meeting of Colorado Counties, Inc., or CCI, a nonprofit organization whose mission is to “offer assistance to county commissioners, mayors, and council members and to encourage counties to work together on common issues,” nearly 100 people were in attendance, almost exclusively in opposition.
Common points among speakers included the fact that it is already difficult to find people to serve on boards in rural areas, that there is little or no budget in smaller counties to pay a separate board, and that elected officials are held accountable to the citizenry in a way that volunteers should not need to be subject to.
Grand County Commissioner Merrit Linke spoke directly to the issue of accountability.
“It is true that the BOCC is not trained as public health officials,” recognized Linke. “But an appointee would not be trained to do what
we do, would not be elected, and would not be accountable in the way that we are. Our statutory mission is to provide for the well-being of all the county, to see the big picture, and coordinate all the activities of the county.
“That’s the beauty of the current system; it allows us the opportunity to do that.”
A very different version of the introduced bill did make its way successfully through both branches of the State legislature. It passed third readings in each and was adopted by majority vote in the Senate on May 6 and in the House on May 10.
The final bill still addresses the issue of board of health member requirements but accomplishes this through training requirements rather than board composition mandates.
The approved legislation requires members of local boards of health to attend annual public health training provided by the Colorado Department of Public Health and Environment (CDPHE) and developed in partnership with the Colorado School of Public Health. It further requires the CDPHE to develop guidance on recruiting individuals to serve on local boards of health.
In Grand County, the Engaged Citizens for a Healthier Grand County continues to see an independent board of health as a way to “better help and support the primary roles of commissioners,” according to group representative John Riedel, who holds masters degrees in public health and business administration.
“We are a nonpartisan group of residents who are motivated out of a desire to assure that our public health officials have outstanding resources to help them navigate complex public health issues,” Riedel stated.
“The East Troublesome Fire and the pandemic have highlighted how fragile life can be and why we all have something at stake to protect our health and maintain this wonderful Grand County lifestyle for our families,” explained Kremmling native Therese McElroy, a member of the group who also served as West Grand Schools’ district nurse for many years.
The group describes itself as being made up of “residents with background and expertise in health matters,” including four doctors and a number of nurses, and others with backgrounds in public service, including a judge and some former teachers.
“We are all invested in the well-being of our community,” summarized Riedel.
Riedel presented the group’s written proposal to Commissioners during Public Comment at Tuesday’s regular BOCC meeting, recommending that five to seven residents be appointed to an independent board of health.
The packet offered at the meeting further articulates the group’s goal to “develop an independent Grand County Board of Health for decision-making, communication, and analysis of community health issues that affect citizens of all ages and lifestyles.”
It identifies benefits as including a “cost-effective way to manage [public health] issues (…), adhering to public health guidelines to remove any personal or political issues from interfering with scientific guidelines supporting the health of all Grand County residents.”
It provides research results from the University of Colorado School of Public Health associating independent boards of health with
“significantly more successful public-private partnerships, lower levels of premature mortality from preventative conditions, and lower medical care utilization and costs.”
And it offered several examples of “unique approaches” to public health management in Colorado counties.
County Commissioners stated that they were unaware that the topic was being brought forth on Tuesday and unprepared for discussion at the time. They requested the group schedule a public workshop at future date.
“The Commissioners were wonderful,” Riedel said later of the encounter. “Manager Ed Moyer contacted me right away and gave me some basic information to prepare for the workshop. It was very helpful.”
In the meantime, the conversation has been brought forward to the community as a whole.
Jen Fanning, Executive Director of the Grand County Rural Health Network, reports that the steering committee for the most recent community health assessment and public health improvement plan, conducted pre-COVID, had already identified the creation of an independent board of health as “a strategy to improve the health of the community long-term.”
Fanning points to the “extremely large scope of work” which county commissioners are tasked with guiding and to the broad field of public health, “based on the intersection of medical, dental, mental health, integrated health, public health, and social determinants of health (disparities).”
She notes that, in the best of times, public health has the “potential to be very divisive,” and observes that elected officials are “beholden to their constituents,” possibly creating a conflict of interest in public health decision-making. “This puts the BOCC in a very difficult position, that really no one should have to be in.”
Commissioner Rich Cimino, for one, has indicated that he supports “more community involvement in all County Boards; there are opportunities galore for people to serve if they have interest and talents. Regarding the County Board of Health, I am supportive of adding some community members to the Board.”
Once a date is set, the agreed-upon workshop will be noticed in an upcoming agenda for the Board of County Commissioners, available at co.grand.co.us. Community members will be able to attend in-person or participate via WebEx.
To learn more about the Engaged Citizens for a Healthier Grand County, to request a copy of the group’s proposal for an independent Board of Health, or to discover ways in which you can become involved in the initiative, contact John Riedel at [email protected]